When people living with dementia cannot recognize their impairment
A monthly article brought to you by Senior Services Memory Support Programs

Do people living with dementia recognize their cognitive changes? Family members and caregivers often ponder this question as their loved ones begin experiencing telltale symptoms like memory problems, poor judgement, confusion and behavior changes. For many seniors who have been diagnosed with Alzheimer’s disease or other forms of dementia, they refuse to stop driving, won’t accept in-home care and resist the idea of moving to senior living because they are unaware that they need assistance. The sad truth is that a decline in mental function essentially affects one’s ability to understand and acknowledge the extent of one’s impairment. This leaves caregivers in a tricky spot.

Known as Anosognosia, this lack of awareness differs from the shock and denial that many individuals and families experience following an initial dementia diagnosis. The word anosognosia is composed of three Greek roots, which combine to mean “without knowledge of disease.” Changes in the brain cause individuals with mental illness, traumatic brain injury, brain tumors, stroke, Alzheimer’s disease or other forms of dementia to truly believe that there is nothing wrong with them.

An estimated 60 percent of patients with mild cognitive impairment (MCI) and 81 percent of patients with Alzheimer’s disease exhibit some form of anosognosia. To complicate matters further, levels and areas of self-awareness vary from person to person. A person’s lack of insight into their impairment can be selective or complete, and it can pertain to their memory, general thinking skills, emotions and/or physical abilities.

The ways in which those with anosognosia react to mentions of their deficiencies varies as well. For example, a person with dementia may experience occasional difficulty with language skills, like word-finding and vocabulary, but they may rationalize or explain away these situations with a general excuse about age-related forgetfulness or fatigue. Someone who has anosognosia regarding short-term memory problems, like forgetting to bathe, missing appointments or leaving food to burn on the stove, will typically insist that they do not need help and are fully capable of performing daily activities independently despite clear evidence to the contrary. Some may even react with anger when confronted about their impairment, because they are fully convinced a deficit does not exist.

For caregivers, anosognosia can sometimes be more frustrating to deal with than a loved one’s actual lapses in memory. Their loved one’s abilities are changing before their eyes, but how can you convince them that they are incapable of driving, cooking or handling their finances when they don’t understand they are having cognitive changes? As with most behavioral changes, learning more about the issue can help you stay calm and find alternatives to keep your loved one safe.

Some individuals are so convinced they’re healthy and competent that they may even refuse to go to doctor’s appointments, undergo neurological testing, receive medical treatments or take medications. We are all familiar with the adage “you can’t help those that won’t help themselves.” With dementia, even when someone does not acknowledge the root of their problems or want assistance, intervention of some kind is usually necessary.

Here are some tips that might help caregivers to navigate anosognosia:

• Allow the person you are caring for to do the things they are still able to do safely. For example, if they are still able to fold laundry, let them, or provide them with items, such as towels, for which folding quality is less essential.
• If they are used to paying the bills by check, provide an old check book that they can use so they can still engage in the behavior.
• Suggest that you engage in activities together. For example, cook a recipe together and have the person engage in ways they are still able to.
• Don’t take it personally: Anosognosia can cause the person with dementia to say hurtful things. As difficult as it can be, try to remember that it is the disease talking and don’t take it personally.
• Is it safe or unsafe?: Before you intervene, ask yourself if what the person is doing is unsafe. If it’s not unsafe, you can decide not to intervene.
• Connect with their emotions, rather than reasoning: You cannot reason with someone who has anosognosia, so as tempting as it can be, don’t try and convince the person with dementia to see things from your perspective. Instead, try and connect with the person’s emotions.
• Check your emotions first: If the person with dementia is about to engage in an activity that puts their safety at risk, be aware of your own emotions. Take a moment to regulate yourself before you engage.
• Agree, stretch the truth, and distract: For example, if the person with dementia is angry that they cannot drive, empathize with their anger (agree it’s difficult), say the car is in the shop for repairs (stretch the truth), and suggest an activity you know they would enjoy (distract).

Senior Services offers an array of memory support programs including free and confidential memory screenings to obtain a cognitive baseline, our early memory loss program, and educational classes along with support from Seasons Adult Day Health Services. If you or someone you know is experiencing increasing changes with their memory and could benefit from additional services, please contact Amy Sheridan, Family Support and Activity Manager at 989-633-3764.

Please continue to check out the section, Our Mind Matters, next month.